POS0504 COMPARISON BETWEEN « SYSTEMATIC » VERSUS « RECOMMENDATION-BASED » VERTEBRAL FRACTURE ASSESSMENT REALIZATION DURING DUAL ENERGY X-RAY ABSORPTIOMETRY EXAMINATION
Authors: M. Mina, P. Salpetier, L. Seidel, M. Leroy, L. Leonori, M. Malaise, C. Ribbens, O. Malaise
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Realization of a thoraco-lumbar lateral view X-ray (Vertebral Fracture Assessment, VFA) when performing Dual Energy X-ray Absorptiometry (DEXA) is proposed in international guidelines to detect asymptomatic vertebral fractures. However, there is no clear consensus regarding indications of its realization. <h3>Objectives</h3> First, we compared the efficiency of a systematic VFA realization during DEXA versus its realization according to different criteria available in literature. Second, we looked after risk factors associated with vertebral fractures. <h3>Methods</h3> 401 successive patients underwent DEXA with a thoraco-lumbar lateral view X-ray (VFA). Medical files were retrospectively reviewed to determine if the patient should have benefited from a VFA according to the ISCD (International Society for Clinical Densitometry) 2007 criteria, ISCD 2015, NOF (National Osteoporosis fundation) 2014, SFR (French Society of Rheumatology), NHG (Nederlands Huisartsen Genootschap) 2nd revision or NHG 3rd revision. <h3>Results</h3> Among 401 successive patients who underwent systematic VFA, a vertebral fracture was observed in 71 patients (17.7%). 74, 54, 62, 73, 12 and 53% of patients should have undergone a VFA according to the ISCD 2007, ISCD 2015, NOF 2014, SFR, NHG criteria 2nd revision and NHG 3rd revision respectively. With the exception of the NGH 2nd revision criteria which only identified 28.2% of fractures, there was no significant difference in fracture detection between "systematic VFA" and "VFA realized following the recommendations" groups. Criteria sensitivity varied between 81.7 and 91.6% of detection, with the best detection performance for SFR criteria. The ISCD 2015 criteria presented the best sensitivity/ specificity ratio of detection. The NHG2 criteria were the most specific (40.8% of VFA positive for fracture) but they lack of sensitivity, compared to systematic use, missed the detection of 51 fractures (12.7%). The detection of a vertebral fracture was significantly more frequent in patients with low bone mineral density at lumbar spine, femoral neck, but also wrist. Age, menopause, height loss, hip fracture in a parent, back pain, COPD, active smoking and inhibitor of proton pump (PPI) use were also associated with higher fracture detection. <h3>Conclusion</h3> VFA realization based on literature criteria has a detection sensitivity between 82 and 92% (with the exception of the NHG 2nd revision criteria), with the SFR criteria having the best detection capacity and the ISCD 2015 criteria the best sensitivity/ specificity ratio. Use of the VFA realization criteria may help to better determine the selection of patients requiring a VFA: VFA realization based on these criteria did not detect significantly less fracture that the systematic VFA realization. Low bone density, loss of height and history of hip fracture in parents were associated with vertebral fracture. Among medical history, attention should be paid to COPD, smoking and PPI use, also associated with the demonstration of a vertebral fracture. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.